Organization
FREEPATH PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDI RICHARDSON (CONTROLLER)
(239) 278-1155
Entity
Organization
Contact information
Practice address
4412 W OSBORNE AVE, TAMPA, FL 33614-6963
(239) 278-1155
Mailing address
4412 W OSBORNE AVE, TAMPA, FL 33614-6963
(239) 278-1155
Taxonomy
Speciality
Code
Description
License number
State
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
Primary
—
—
Other
Enumeration date
08/24/2007
Last updated
08/24/2007
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